Abstract
Ethics
Do you find it difficult to cover topics in tutorials for the ethics section of the GP curriculum (3.3: Ethics and value-based medicine) or complete the ‘maintaining an ethical approach’ and ‘fitness to practice’ sections of case-based discussion?
The General Medical Council (GMC) has an interactive website to illustrate ethics points. There are currently two sections with a simple interactive format where you click on patients in a waiting room to highlight details of the case, answer questions and view the opinions of experts. The second in the series of these ‘waiting rooms has been released and focuses on children and consent.
The website could be used individually or as the basis of a group discussion. You do not need to register to use the site, although there is opportunity to give feedback. Good Medical Practice, GMC, www.gmc-uk.org/guidance/case_studies/index.asp.
What do you think about rationing of care on financial grounds?
From January 2009, new, more relaxed National Institute of Clinical Excellence (NICE) guidelines apply to the prescription of some end of life drugs. To qualify for the new approach, drugs must meet specific criteria: small patient population, short life expectancy, extension of life expectancy and no alternative treatment with comparable benefits available through the NHS. At around the same time, the Health Secretary announced that patients are to be allowed to pay privately for treatment with expensive drugs without losing their entitlement to NHS care.
Think about patients outside these limited groups. NICE is using different financial criteria to assess end-of-life treatment for them. There may be patients who cannot afford to buy expensive drugs. It might be worth spending some time thinking about how such decisions are made, whether you would make them the same way and how you will deal with requests for treatments that are not currently funded.
The first baby in the UK to have preimplantation diagnosis for the BRAC1 mutation (linked to breast cancer) has been born. Patients will often turn up in the surgery (or the Clinical Skills Assessment) with problems about which you know little. No one is expected to know everything. Think about how you cope with telling patients that you do not know the answer. In both your workplace and in the exam, you will find gaps in your knowledge. It might be worth deciding in advance how you will deal with the unknown and how you will look up information.
NHS Constitution
‘The new NHS Constitution is something which all GPs, their practice teams and NHS staff can commit to and have confidence in. I'm convinced that it will be an important, defining point in the development of our NHS.’ This is part of the press release statement by Professor Steve Field, chair of the Royal College of General Practitioners (RCGP), on the publication of the first NHS Constitution.
It sets out the rights and responsibilities of both patients and staff. Of particular note to general practice is that it clearly states that patients should register with a general practice — the main point of access to NHS care.
Do you think there is a need for a written constitution? Think about the suggestion that patients have responsibilities as well as rights and ask yourself whether you agree. Read it for yourself (it is remarkably short) and discuss with your colleagues. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_093419
The Emergency Planning Group (jointly run by the RCGP and General Practitioner Committee) has published guidance as to how GP's practices should prepare for and operate during a flu epidemic. Do you know what your practice has planned? Your practice probably has a variety of protocols. It might be worth finding out who is responsible for them in your practice, how they are drawn up and how they are kept up to date. When you finish your training, how are you going to keep up to date with guidance? Before you leave your practice, it is worth working out the mechanics of how you are going to get journals and information sent to you as well as how you are going to keep up to date without being swamped with information.
Have you seen the new prescription exemption charges forms for England? From April 2009, patients being treated for or suffering from the side effects of treatments for cancer will be able to get free prescriptions. Exemption for charges for other long-term conditions will be introduced later in the year.
There is a degree of discretion in the interpretation of the exemption; you may wish to discuss this. You could actively search for patients from your practice undergoing treatment and check that they get the new form signed www.dh.gov.uk/en/Healthcare/Medicinespharmacyandindustry/Reviewofprescriptioncharges/index.htm
NICE has published guidelines on medicines adherence (www.nice.org.uk/CG76). The focus is on communication and involvement of patients in prescribing decisions rather than assuming non-adherence to be the patient's problem. There is a quick reference guide which is very readable. This sort of issue is common in practice (and the CSA). Do you liaise with your local pharmacists? They often have useful ideas to help patients; not necessarily just a ‘dosette box for all’ approach.